The URL can be used to link to this page

Home My WebLink About1904 CAMINO VIDA ROBLE; ; CB973852; Permit' „ • ' BUILDINGPERMIT 12/22/97 14:11 Page 1 of 1 Job Address: 1904 CAMINO VIDA ROBLE Suite: Permit Type: ELECTRICAL Parcel No: Lot#: Valuation: 0 Co Occupancy Group: Referenced Description: TEMP POWER POLE Permit No: CB973852 Project No: A9704967 Development No: ISSUED 12/2 Apr/Issue: 12/22/97 Entered By: MDP Appl/Ownr : TEMP. POWER SYSTEMS 750 N.CITRACADO PKWY. #4 ESCONDIDO, CXA. 92120 *** Fees Required *** 760 439-1999 Fees Collected & Credits Fees: Adjustments: Total Fees: Fee description Enter "Y" for Elec Enter "Y" for Tern * ELECTRICAL TOTA 20. nit *** . 00 .00 20.00 Ext fee Data 10.00 Y 10.00 Y 20.00 HLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 Li i - : PROJECT INFORMATION ", 1 .<• L*:-,- FOR OFFICE USE ONLY PLAN CHECK EST. VAL. Plan Ck. Deposit Validated By, Date _ include Bldg/Suite #)Business Name {at this address) Legal Description "Mi Lot No.Subdivision Name/Number Unit No.Phase No. Total # of units Assessor's Parce Existing Use Proposed Use Description of Work i£^CONTACf; PERSONTitf iffffwMtAvm applicant)K^-^ SO. FT.#of Stories "lira # of Bedrooms # of Bathrooms Name Address Fax It Address City litate/Zip Telephone #Name f5/i'CONtRACTOR-COMPANY NAME (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he is exempt therefrom, and the basis for the alleged exemption. Anyv*«lation of Sectio.n.7031.5 by any applicant for ayermit subjects thwpplicant to^ civil penalty of not more tin* five hundred doUars IS50011. Name ' yv_ State License * T^O-^7^ Designer Name State License ft 6- WORKERS' COMPENSAT s Address ^p •^ "^ License Class ( — - f \^) Address ION'.."-!"' "•- ,"-; :£*'-"*"' ." •* •'.'•'*'?• ;;--i^v -L, ^v^^- " ;^.;*{.'X' City City Business City ^SS^^^-^S^SSS State/Zip License # State/Zip Pi^SSS^Si Telephone # Telephone ^^•S^^SiSSFttf'- -rift^Mjfe-J];.-^* jJ* Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: n I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the^work for which this permit is issued. j0i 1 have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: / Insurance Company f -^T^^^"—-^f-j^&^^f^J^ C^ Policy No. /\Jfj£s rr~ /£*0<^^ Expiration Date_ _ {THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) f ~^~~ Q CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to seoprtf workers' compensation coverage i* unlawful, and shall subject an employer to criminal penahtia/and civfTfines up to one hundred thousand dollars (SI 00 jBtSffi In j^dition/4o we cost of compensation, damages as provided for in Section 3706 of the Laborcaae, interest and Attorney's feet. SIGNATURE J*cPftJ /Z^^/^y" , DATE /"^/ <P&*-/&* sJi "-"'• OWNER-BUILDER DECLARATION^ *-•>•<»"V ^pjs.i.vk.tlijtS^'^f--f-^~ffSi^~.^.'"fegy*S^&.'»~?£g^"x~^-7-~i"i*$?*;'!>'-^^*^~^^;%^?'^"^i^$"'ff^ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: Q I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec, 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). Q I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Coda: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). n I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Q YES QNO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contractors license number); — 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated {include name / address / phone number / type of work): .... „ PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q VES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Q NO Is the facility to be constructed within 1 ,000 feet of the outer boundary of a school site? Q YES Q NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. &!£.PPNS^RUCT™ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME LENDER'S ADDRESS I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commejjced within 365/days from the date of such permit or if the building or work authorized M such permit is suspended or abandoned at any time after the workja^^rtmBii^J fjrt a period of 160 days (Section 1O6.4.4 Uniform Building Code}. APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance PERMIT* CB973852 DESCRIPTION: TEMP POWER POLE CITY OF CARLSBAD INSPECTION REQUEST FOR 02/04/90 TYPE: ELEC JOB ADDRESS: 1904 CAMINO VIDA ROBLE APPLICANT: TEMP. POWER SYSTEMS CONTRACTOR: OWNER: REMARKS: C/BOB/439-1999 SPECIAL INSTRUCT: INSPECTOR AREA TP PLANCK# CB973852 OCC GRP CONSTR. TYPE VN STE: LOT: PHONE: 760 439-1999 PHONE: PHONE: INSPECTOR TOTAL TIME: _ CD LVL DESCRIPTION 32 EL Const. Service/Agricultural ACT COMMENTS A& tfu ***** INSPECTION HISTORY ***** DATE DESCRIPTION ACT INSP 012698 Const. Service/Agricultural CO TP COMMENTS DN STRM WIRE TERM? AttOffll. CERTIFICATE OF PRODUCER Milestone Insurance Agency 8 Corporate Park, #130 Irvine, CA 92714-5105 (714)852-0909 Pax<714) 852-1131 NSURED Temp Power Systems, Inc. 1111 N. Tustin Avenue Anaheim, CA 92807 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANDCONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATEDOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THEPOLICIES BELOW. COMPANIES AFFORDING COVERAGE A California Indemnity Ins. Co COMPANY LETTEH COMPANY D COMPANY iETTEH THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERSN IS SUBJECT TO All THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. •m;OPor HUIHERNUMBER *JUCV °«CTiVE(MM/DDffY)K>ucv EXPIRATIONDAT«<MM/IXWY) QEHERAL UAflUJTf \ \ COMMERCIAL GENERAL LIABLITY j CLAWS MADE \ ioccun. j OWNEffS & CONTRACTOR'S PROT, GENERAL AQQHEGATE * PTODUCTS-COMWOP AGO. !$ PERSONAL & ADV. INJURY is EACH OCCUmENCE > RRE DAMAGE (Any ont On) * MED. EXPENSE (Any win f»n<xi)'$ ANY AUTO -. AU OWNED AUTOS ! SCHEDULED AUTOS i HIHEO AUTOS j NON-OWNED AUTOS ; QARAQE LIABILITY ! COMBWED SINGL£ !LWIT i BODILY INJURY BOO1.Y INJURY ^' Kcawtl ; PROPERTY DAMAGE EXCESS UABUTY EACH OCCURRENCE : OTHEFI THAN UMBRELLA FORM WORKER'S COHPEXSATION 6044720C h.0/01/97 • 10/ Ol/ LX J. STA"JTOTY UM1TS °" AC(IDENT EHPLOYERV UAMLTTY i DISEASE -'POUCY UMIT fj" 1.,000 • ...... ......................... : ...... ^'wk« « « Ai DISEASE - EACH EMPLOYEE * 1, 000,000 DESCfHPTIDN OP OfDUTXWBftjOCATWH8rteHBl*a««Cttt ITE1I8 RE: License 483443 *10-dav notice of CANCELLATION in the event of non-payment of premium Contractors State License Board P.O. Box 26000 Sacramento, CA 95826 as-s SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WIU. ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE